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Cigarettes and Tobacco Use in Mental Health Settings

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The growing trend in most mental health centers is banning tobacco products and their use on campuses that deliver treatment and other supportive programs. 

When I first entered the mental health system, I was an adolescent in an in-patient unit in New York State. Within a year of the time, I landed in the hospital. Smoking was already banned for adolescents. Before the banning, adolescents could smoke outside the building when they were granted outdoor privileges. The rationale, I was told at the time, since minors weren’t allowed to purchase cigarettes in the community, they shouldn’t be smoking in the hospital. This I accepted with a giant grain of salt. After all, I was a smoker, irritable, but appreciative enough of logic in a place and time where reason wasn’t readily available. 

However, when I was hospitalized in the New York State Psychiatric Center in upstate New York a mere five years later, smoking was banned for all patients, staff, and visitors on the hospital campus. This is where I drew a line in the sand and took issue. At this time, I was just agitated. I was dysregulated, manic, and psychotic. I needed soothing, and self-soothing skills were not cutting it—therapy wasn’t cutting it either to regulate my mood and clear my head. Oh, heck, my medication wasn’t yet where it needed to control my symptoms in the least. 

Given how bewildered, uncomfortable, and upset I was back then from new active schizophrenia symptoms.

I needed relief and quickly. To be even blunter, I needed a cigarette. 

My theory about smoking in the hospital is simple and is within the margins of psychology and elementary logic. When a person is so far from a baseline that all previously learned coping skills don’t work anymore, why deny people the use of their existing mechanisms for finding relief in the most challenging moments of perhaps their life? Why take away the only coping skill that has been working to date? Why must we throw additional barriers in someone’s way to deescalating and finding a moment of peace in a disordered mindset when someone is so sick? 

I understand the need and push to ban tobacco use in community health settings. Sure, teach people to access coping skills free of tar, toxins, and health-compromising chemicals. Instead, we need people to learn how to lean on healthier supports and access community resources. In this vein, I am not suggesting pushing cigarette smoking on people who do not already smoke or allowing tobacco companies to come into the hospital and hand out products to vulnerable people and get them addicted to another chemical they will need to manage moving forward discharge. 

However, for people with existing habits and already smoke. Why limit, restrict, and agitate these folks further when they could be enjoying a smoke outside like at their own home and maybe feel the impetus to work towards discharge to do just that. 

People at the out-patient level are more likely to use other coping mechanisms to find relief instead of smoking or wait until they get back home at the end of their session or program. Still requiring research is the threshold, that space where the risks of smoking outweigh the benefits of non-smoking and wearing a nicotine patch until that too is ultimately discontinued, especially for extremely disordered, chronic, and comorbid smokers. 

In my opinion, this new shift in so-called healthier practices and wellness overlooks a part of human nature, personal freedom, and introductory psychology. Some people with cognitive deficits and symptoms are so intense that learning new skills will not outpace the cravings or pleasure derived from puffing on a cigarette.

These people will not learn new coping skills fast enough to benefit from not smoking and will be even more uncomfortable and agitated during a tremendously already agitating point in their mental health.

When people are pushing freedom and personal choice in treatment, I am genuinely shocked the hospitals were so fast to embrace the smoking ban. I have been so sick that I wouldn’t get out of bed for days at a time. It wasn’t a pill or the promise of deep breathing that motivated me to get out of bed. It was a cigarette and coffee. When a person is genuinely symptomatic, in terms of coping skills, it is genuinely about going back to the basics and clinging to what works, what you know, and what you feel will make you feel better in the moment. I genuinely hope the hospitals discontinue this movement and revert, at least in part, to an earlier time when life’s pleasures weren’t removed/banned without consent or choice.

 

 

About the Author

J. Peters

Max Guttman '08, MSW '12, is the owner of Recovery Now, a private mental health practice. Through his work as a Licensed Clinical Social Worker, therapist and disability rights advocate, Max fights for those without a voice in various New York City care systems. He received a 2020 Bearcats of the Last Decade 10 Under 10 award from the Binghamton University Alumni Association.

Guttman treats clients with anxiety and depression, but specializes in issues related to psychosis or schizoaffective spectrum disorders. He frequently writes on his lived experiences with schizophrenia.

"I knew my illness was so complex that I’d need a professional understanding of its treatment to gain any real momentum in recovery," Guttman says. "After undergraduate school and the onset of my illness, I evaluated different graduate programs that could serve as a career and mechanism to guide and direct my self-care. After experiencing the helping hand of my social worker and therapist right after my 'break,' I chose social work education because of its robust skill set and foundation of knowledge I needed to heal and help others."

"In a world of increasing tragedy, we should help people learn from our lived experiences. My experience brings humility, authenticity and candidness to my practice. People genuinely appreciate candidness when it comes to their health and recovery. Humility provides space for mistakes and appraisal of progress. I thank my lived experience for contributing to a more egalitarian therapeutic experience for my clients."

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